A joint report launched on 12 September 2016 at the Fairer Futures: Reshaping Care for Older People day symposium, argues that, with a social innovation approach, local authorities could provide better home care which benefited carers and cared.
Published to coincide with the symposium, a collaboration between Alliance Manchester Business School’s Health Services Research Centre, the Fairness at Work Research Centre and the Manchester Institute for Collaborative Research into Ageing, the report argues that having good intentions alone in adult care is not enough.
It says that in adult care, the central state and expert community have promoted the worthy aims of personalisation of care and outcomes-based commissioning. But, partly as a result of austerity cuts, adult social care is a sector now facing multiple crises. There is a financial crisis in terms of service cuts, a care quality crisis, a workforce recruitment and retention crisis and a provider crisis resulting from squeezed margins.
Report co-author Karel Williams, Professor of Accounting and Political Economy at Alliance Manchester Business School says: “There is a painful gap between the policy makers’ rhetorical promise of choice, control and independence afforded by home care and the lived experience of the majority of the 600,000 old people who receive home care. This may keep people in their own homes and living independently but it is not delivering consistently high quality care.”
Set out in three sections, the report analyses the root causes of this disappointment and explains how the sector has made uneven and inconsistent progress towards the worthy aims of policy and concludes with a proposal of an alternative radical social innovation approach to the problem.
The report argues:
· A hyperactive central state has driven reforms in the sector, with local authorities encouraged to view home care through a narrow market citizenship lens. Personal budgets, direct payments and local authority sponsorship of competitive markets have disappointed in the case of elderly because they are built on a limited understanding of choice, control and independence, and because they accept as given the business model of providers and the commissioning practice of local authorities.
· The activity specifics of home care intersect with the providers’ sectoral business model to create an intractable mess so that putting more state money in is a necessary but not sufficient condition of reform. Home care is delivered by travelling carers on rounds performing physical maintenance tasks on short visits. The branch retail business model of organising rounds produces firms with different cost structures and discretion about pursuing objectives of resilience or cash generation: underpaid providers demand a fair price from Local Authorities but there cannot sensibly be one price for all firms in an area.
· What we need is a new agenda of radical social innovation that promotes a much broader notion of full citizenship for carers and cared who both have rights to a decent living. The report argues that change should be led by authority commissioners, empowered by mobilisation of a political coalition for change; we need to engage old people and other citizens in political debate and choices about provision for the elderly.
For the proposed recommendations and full research findings, download the report here >>